31 Aug

Nutrition

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Content

• Various Initiatives to fight malnutrition in the country
• MICRONUTRIENTS vs Macro Nutrients
• Fortification of Food
• Diseases due to Nutritional Deficiencies
• Anaemia

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1) VARIOUS INITIATIVES TO FIGHT MALNUTRITION IN THE COUNTRY

• The government is implementing several schemes and programs under the Umbrella ICDS Scheme as direct target interventions to address the problems of malnutrition in the country.
• Initiatives like PDS, Mid-Day Meal Scheme.
  • In Sep 2021, the Mid day meal scheme has been renamed to PM POSHAN.
    • Under this not only Children of class 1 to 8 (around 11.8 crore) will be covered, but also around 24 lakh students receiving pre-primary education at government and government aided schools will also be brought under the ambit of the scheme from next year. This is in line with NEP which had recommended that the pre-school education should be formalized.
• Poshan Abhiyan (POSHAN -> PM’s overarching scheme for holistic nutrition) (earlier known as National Nutrition Mission) is being implemented since 2017. It is aimed at reducing malnutrition in the country in a phased manner, through a lifecycle approach. It focuses on children, pregnant women, and lactating mothers.
  • It has an aim to build a people’s movement (Jan Andolan) around malnutrition.
  • For implementation of POSHAN Abhiyan the four-point strategy/pillars of the mission are:
    • Inter-sectoral convergence for better service delivery
    • Use of Technology (ICT) for real time growth monitoring and tracking of children
    • Intensified health and nutrition for the first 1000 days
    • Jan Andolan
  • Target was to bring down the stunting of the children in the age group of 0-6 years to 25% by the year 2022.
• Mission Poshan 2.0
  • COVID-19 had worsened the situation and therefore, it was important to multiply our efforts towards Poshan 2.0 with full vigour.
    • It is an umbrella program that encompasses ICDS (Anganwadi Services, Poshan Abhiyan, Scheme for Adolescent Girls, National Creche Scheme ). It was announced in Union Budget 2021-22 and has merged supplemental nutrition programs and the POSHAN Abhiyan to tap the synergies.
    • Under this, malnutrition hotspots and aspirational districts will get extra attention.
• Steps to promote AYUSH systems for prevention of malnutrition and related diseases.
• A program to support development of Poshan Vatikas at Anganwadis centres to meet dietary diversity gap leveraging traditional knowledge in nutritional practices.
• NFSA, 2013 which provides for coverage of upto 75% of the rural population and upto 50% of the urban population for receiving highly subsidized food grains under TPDS.
• Pradhan Mantri Garib Kalyan Anna Yojna (PMGKAY)

2) MICRONUTRIENTS VS MACRO NUTRIENTS

 

A) MICRONUTRIENTS

• These are the vitamins and minerals that our bodies need each day in order to properly function. Unlike macronutrients they are needed in small amounts.
  • Vitamins can be classified into 13 major types: Vitamins A, B-Complex (Thiamine, riboflavin (Vitamin B2), niacin, pantothenic acid, biotin, vitamin-B-6, Vitamin B12, and folate), C, D, E and K.
    • They are organic compounds. They can be classified into two categories:
      1. Fat Soluble
         • A,D, E and K
         • Important role in overall health by promoting healthy bones, skin, eyesight, lungs and digestive systems.
      2. Water Soluble
         • B-Complex and C
         • Not stored in fat (like fat soluble vitamins), so daily consumption is important.
         • They boost metabolism, act as powerful antioxidant and assist in the formation of collagen helping in healing wounds.
    • Vitamin D
      • Vitamin D is an essential vitamin that helps regulate calcium and phosphorus in the body. It also plays a role in maintaining bone structure.
      • There are different forms of Vitamin D, including ergocalciferol (Vitamin D2) and Cholecalciferol (Vitamin D3).
        • It is found in fish, eggs and fortified milk. It’s also made in the skin when exposed to sunlight. During periods of sunlight, Vitamin D is stored in fat and then released when sunlight is not available.
  • Minerals can be further classified as major minerals and trace minerals.
    • The six major minerals include sodium, potassium, chloride, calcium, phosphorus and magnesium. They are required in large amounts in body as compared to trace minerals. They are important for maintaining proper fluid balance and electrolytes (sodium and potassium) as well as help in supporting bones, hair, skin and nail health.
    • Trace minerals arerequired in smaller quantities, but areas important as major minerals. The nine trace minerals include cooper, zinc, iron, iodine, manganese, molybdenum, cobalt, selenium and fluoride.

 

B) MACRO-NUTRIENTS

• These are the main nutrients that make up the foods we eat. There are three macro-nutrients –Carbohydrate, Protein and Fat.

FATS – SIGNIFICANCE – LIMITATIONS AND TYPES

• Significance of fats as nutrients
  • It is the most concentrated form of energy. Body uses fat as a fuel source and as major storage of energy.
  • It helps in absorbing vitamins like A, D, E and K.
  • They also provide cushioning for the organs.
  • They are an important constituent of cell membrane and provide taste, consistency, and stability.

 

C) TRANS FAT VS SATURATED FAT VS MONO-SATURATED FAT VS POLY-UNSATURATED FAT

• All fats have a similar structure – a chain of carbon atoms bonded to hydrogen atoms.
• The differentiating factor is the length and shape of the carbon chain and the number of hydrogen atoms connected to the carbon atoms.

 

(1) Trans Fat (worst type of dietary fat)

• • According to the World Health Organization, approximately 5.4 lakh deaths take place each year globally because of the intake of industrially produced trans fatty acids. They come in both natural and artificial forms.
  • Trans fats are the result of partial hydrogenation of unsaturated fat. This turns healthy oil into solids.
    • Process: Heating liquid vegetable oils in the presence of hydrogen gas and a catalyst, a process called hydrogenation.
    • Advantages:
      • Partial hydrogenation of vegetable oil makes them more stable and less likely to become rancid. The process also converts the oil into a solid, which makes it easy to handle.
      • Partial hydrogenation oils can with stand repeated heating without breaking down, making them ideal for frying fast foods.
    • Note: Partial hydrogenation is not the only source of trans-fat in our diet. Trans fats are also naturally found in beef fat and dairy fat in small amounts.
    • Trans fats have no known health benefits and no safe level of consumption.
  • Disadvantages:
    • Trans-fats are worst type of fat for the heart, blood vessels, and rest of the body:
    • Eating trans-fat increases harmful LDL (low density lipoprotein) cholesterol in the blood stream and reduces the amount of beneficial HDL (high density lipoprotein) cholesterol. It is linked to heart disease, stroke, diabetes, and other chronic conditions.
    • They contribute to insulin resistance.
  • It is banned in many countries. India currently allows trans-fatty acids upto 3% (by weight).
  • In Jan 2020, FSSAI has capped the amount of trans fatty acids (TFA) in oils and fats to 3% for 2021 and 2% by 2022, from the current permissible limit of 5% through an amendment to the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations.
  • In May 2018, WHO also gave a call to eliminate trans-fat in foods by 2023.
  • For this WHO has launched an initiative REPLACE, that will provide guidance for all countries on how to remove artificial trans fats from their foods, possibly leading to worldwide eradication.
    • It stands for Review dietary sources, Promote use of healthier fats, legislate, assess changes, create awareness, and Enforce regulation.
    • The initiative promotes countries to establish legislation to eliminate the trans-fats.

 

(2) Saturated Fats

• • A saturated fat is a type of fat in which the fatty acid chains have all or predominantly single bonds.

• • Common source of saturated fats are red meat, whole milk and other whole milk dairy products, coconut oils etc.
  • Health Impacts
    • Can drive harmful LDL cholesterol.
    • But recent research, have again raised the debate whether saturated fats are actually harmful and cause heart disease.

 

(3) Monounsaturated Fat and Poly Unsaturated Fats

• • Monounsaturated Fats are fatty acid chains that have one double bond in the fatty acid chain with all the remainder carbon atoms being single-bonded.
  • Poly Unsaturated Fats are fatty acids with more than 1 double bond.
  • Thus, these fats have fewer hydrogen atoms bonded to carbon atoms when compared to saturated fats.
  • They are liquid at room temperature.
  • Sources of monounsaturated fats
    • Olive Oil, peanut oil, canola oil, avocados, nuts etc.
  • Sources of Polyunsaturated oils
    • Corn oil, sunflower oil, and safflower oil, fish oil etc. are common examples.
    • These are essential fats and are required for normal body functioning, but our body can’t make them. They are used in building of cell membrane and covering of nerves. They are also needed in blood clotting, muscle movement and inflammation.
  • Two Main types of Polyunsaturated Fatty Acids
    • Omega-3 Fatty Acids
    • Omega-6 Fatty Acids

3) FORTIFICATION OF FOOD

 

A) FOOD FORTIFICATION

• • Fortification means deliberately increasing the content of essential micronutrients (suchasiron, folic acid, iodine, vitamin A, Zinc etc) in a food so as to improve the nutritional quality of food and to provide public health benefits with minimal risk to health. According to FSSAI it is a scientifically proven, cost effective, scalable and a sustainable intervention that addresses the issue of micronutrient deficiencies.
  • Advantages of Food Fortification over other nutrition fulfillment mechanisms:
    • Cost Effective:
    • Well Proven Method: It has been used around the world since 1920s. The World Health Organization (WHO), UNICEF, and the Gates foundation, to name only a few, endorse food fortification as a primary means of improving micro-nutrient health.
    • Eating Habits not needs to be changed
    • Socio-culturally more acceptable
    • Scalable and Sustainable: Can be introduced quickly and can provide nutritional benefit to people in short period of time.
• Different ways in which people get micro-nutrients and why food fortification can be effective.
  • Since most population in resource-poor settings do not have access to adequate quantities of fruits, vegetables, and meats  where micronutrients are abundant, and because providing vitamin tablets poses logistical and economic constraints, food fortification is a practical and inexpensive alternative.

 

B) BIOFORTIFICATION:

• • Biofortification is the process by which the nutritional quality of the food crops is improved through agronomic practices, conventional plant breeding, or modern biotechnology.
  • It aims to increase nutrient level in crops during plant growth rather than through manual means during processing of the crops.
  • Biofortification may therefore present a way to reach population where supplementation and conventional fortification activities may be difficult to implement and/or limited.
  • Scientists at ICAR have been developing biofortified crops in India with a view to eradicating malnutrition amongst the poor sections of society. As per ESI 2021-22, currently in India the number of biofortified varieties have increased to 87.
    • None of these are GM crops. They have been developed through conventional crop breeding techniques.
  • E.g.
    • Zinc biofortification of wheat, rice, beans, sweet potatoes and maize

 

C) RICE FORTIFICATION: EXTRUSION TECHNOLOGY:

• • In his Independence Day Speech (Aug2021), PM Modi announced fortification of rice distributed under various government schemes, including the PDS and midday meals in schools, by 2024.
  • Various technologies are available for rice fortification – coating, dusting etc. But ‘extrusion’ is considered the best technology. This involves the production of fortified rice kernels (FRKs) from a mixture using an extruder machine. The fortified rice kernels are then blended with regular rice to produce fortified rice.
  • How does extrusion technology to produce FRK work?
    • Dry rice flour is mixed with a premix of micronutrients, and water is added to this mixture. This mixture then goes into twin-screw extruder with heating zones, which produce kernels similar to shape and size to rice. These kernels are dried, cooled and packaged for use. FRK have shelf like of at least 12 months.
    • As per the guidelines issued by the Ministry of Consumer Affairs, Food and Public Distribution, the shape and size of the fortified rice kernel should “resemble the normal milled rice as closely as possible“. According to the guidelines, the length and breadth of the grain should be 5 mm and 2.2 mm respectively.
  • According to FSSAI norms, 1 kg of fortified rice will contain the following:
    • Iron (28 mg-42.5 mg), folic acid (75-125 microgram), and vitamin B-12 (0.75-1.25 microgram).
    • Rice may also be fortified with zinc (10 mg-15 mg), vitamin A (500-750 microgram RE), vitamin B-1 (1 mg-1.5 mg), vitamin B-2 (1.25 mg-1.75 mg), vitamin B-3 (12.5 mg-20 mg) and vitamin B-6 (1.5 mg-2.5 mg) per kg
  • Why is rice fortification needed?
    • High levels of Anaemia and malnutrition in India. Rice is a stable crop of India.
  • Cost of fortification:
    • The Ministry estimates that the cost of producing FRK with three micronutrients – iron, folic acid, and vitamin B-12 – will come to around Rs 0.6 per kg. This cost is shared between centre and states and government will pay this cost to rice millers.
  • Identification:
    • Fortified rice will be packed in jute bags with the logo (“+F”) and the line “Fortified with Iron, Folic Acid, and Vitamin B12″ will be mandatorily printed on them.
  • Has any other country done this?
    • Rice fortification is mandatory in 7 countries: The USA, Panama, Costa Rica, Nicargua, Papua New Guinea, Phillipines, and the Solomon Islands.

4) DISEASES DUE TO NUTRITIONAL DEFICIENCIES

Disease	Deficiency of	Other comments
Rickets	Vitamin D along with calcium and potassium	- Ricketsischaracterizedbyweakandsoft bones,bowedlegs and bone deformities. - Fish, fortified dairy products, liver, oil and sunlight are some rich sources of vitamin D.
Osteoporosis	Vitamin D with Calcium	- Deficiency of Vitamin D and calcium in the body can negatively affect the health of the bones and spine. It leads to unhealthy, soft and brittle bones that are prone to fractures and defects in the spine structure. - Bananas, spinach, milk, okra, soy and sunlight are natural sources of Vitamin D and calcium that act to eliminate this deficiency
Pellagra	Vitamin B3 or Niacin	- 4D's: Dementia, diarrhea, dermatitis and death are the four Ds that characterize Pellagra. - Tuna, whole grains, peanuts, mushrooms, chicken etc.
Scurvy	Vitamin C or ascorbic acid	- Scurvy basically inhibits the production of collagen in the body which is the structural protein that connects the tissues. • Decaying of skin and gums, abnormal formation of teeth and bones, delay or inability to heal wounds and bleeding are the effects of scurvy - Vitamin C can be derived from Citrus fruits like oranges, lemon, strawberry etc. and Broccoli regularly
Beri-Beri	Vitamin B1 or Thiamin	- The most common symptoms of this illness are altered muscle coordination, nerve degeneration and cardiovascular problems. - Meat, eggs, whole grains, dried beans etc are rich in thiamine and thus, should be consumed in proper amounts every day to avoid this painful ailment
Xerophthalmia or Night Blindness	Vitamin A	- Xerophthalmia or night blindness is characterized by blindness due to the poor growth, dryness and keratinisation of epithelial tissue or chronic eye infection. - In worsened situations, night blindness can aggravate to complete loss of vision - The safest way to enhance the Vitamin A levels in the body is byconsumingnaturalfoodsourceslikecarrots,greenand leafy vegetables, cantaloupes etc
Goitre	Iodine	- Goitre leads to enlarged thyroid glands causing hypothyroidism, poor growth and development of infants in childhood, cretinism and even mental retardation - This disease is commonly found to occur in places having iodine deficit soil. Iodised salt and saltwater fish are rich sources of iodine, and must be consumed regularly to avoid goitre.
Anaemia	Iron	- It is characterized by a decrease in the red blood cell count or haemoglobin in the body, resulting in fatigue, weakness, dyspnoea and paleness of the body. - It can be easily treated by changing to a healthy diet and consuming iron supplements on a regular basis. Squashes, nuts, tofu, bran etc are rich sources of iron for the body.
Kwashiorkor	Protein and Energy	- It is characterized by anorexia, an enlarged liver, irritability and ulcerating dermatoses. - These are the one of the nutritional deficiencies in children, especially from famine-struck areas and places with poor food supply, Kwashiorkor is caused by malnutrition. - A healthy and balanced diet enriched with protein and carbohydrate sources like eggs, lentils, rice etc helps combat this problem
Depression	deficiency of Vitamin B7 or biotin	- This deficiency can be fatal if present in an aggravated form. - Consume poultry products, dairy items, peanuts, nuts etc that are rich sources of biotin. These must be consumed along with supplements to recover and prevent these illnesses

SOME NUTRITION BASED UPDATES

5) ANAEMIA

• What is Anaemia:
  • It is a condition in which number of red blood cells or the hemoglobin concentration within them is lower than normal or there are abnormal red blood ells.
  • This negatively hampers the ability of blood to carry oxygen to tissues (Note: It is the hemoglobin which attaches to oxygen).
  • It results into symptoms such as fatigue, weakness, dizziness, shortness of breath etc.
• Causes:
  • Nutritional Deficiency – particularly iron deficiency, deficiency of folate (vitamin B-9 is important for RBC formation and for healthy growth and function), vitamin B12 and Vitamin A.
  • Haemoglobinopathies – It is a group of disorders in which there is abnormal production or structure of the hemoglobin molecule. These group of diseases include hemoglobin C disease, hemoglobin S-C disease, Sickle Cell Anemia, and Thalassemia.
  • Infectious diseases which impact blood such as malaria, TB, HIV and parasitic infections may also cause Anaemia.
• Impact:
  • Anaemia compromises immunity and impedes cognitive development.
• Global Situation:
  • As per WHO, around 42% of children under 5 and 40% of pregnant women worldwide are anaemic.
• Anaemia Situation in India:
  • Between 2005 – 2015, the anaemia situation declined marginally in India.
  • But, as per the NFHS-5, the incidence of Anaemia in under-5 children (from 58.6 to 67%), women (53.1% to 57%) and men (22.7% to 25%) has worsened in all states of India (20%-40% is considered moderate) (when compared to NFHS-4)
    • Kerala (at 39.4%) is the only state at moderate level. Else all other states are in severe category (above 40%).
• Factors which cause high levels of Anaemia?
  • Cereal centric diet with less consumption of iron rich food groups like meat, fish, eggs, and Dark Green Leafy Vegetables (DGLF).
  • Poor water quality and sanitation may also impact the nutrient absorption.
  • Women’s empowerment can impact the kind of food being consumed by them.
  • Delivery of health and nutritional interventions play a significant role in the prevalence of anaemia.
• India’s great anaemia mystery – class discussion

 

A) ANAEMIA RELATED INITIATIVES

• • The Anaemia Mukt Bharat – intensified Iron-plus initiative was launched in 2018.
  • It aimed to strengthen the existing mechanism and foster newer strategies for tackling Anaemia.
  • Objectives:
    • Complying with the targets of POSHAN Abhiyaan and National Nutrition Strategy set by NITI Aayog, the Anaemia Mukt Bharat strategy has been designed to reduce prevalence of anaemia by 3 percentage points per year among children, adolescents, and women in the reproductive age group (15–49 years), between the year 2018 and 2022
  • It focuses on six target beneficiary groups, through six interventions and six institutional mechanisms to achieve the envisaged target under the POSHAN Abhiyan. This is known as 6X6X6 strategy.
  • Are we on track to achieve the targets:
    • No, NFHS-5 has shown an increase in the Anaemia affected population.